3-8% of Women Are Affected by PMDD — Here's How to Manage It

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Lissa Kline, LCSW46
VP of Member and Provider Services at Progyny.
April 20, 2024 at 5:4PM UTC
Many women experience uncomfortable symptoms right before they get their period. And while some may need to take some Ibuprofen for cramps, they can usually go on being a boss despite the fact that their bodies are undergoing a huge hormonal shift each month. 

What is PMDD?

But for women with Premenstrual Dysphoric Disorder (PMDD), this process is totally different. It’s not like Premenstrual Syndrome (PMS), which is characterized by tender breasts, cramps, moodiness, fatigue, and an insatiable hunger for chocolate. People who suffer with PMDD have symptoms so debilitating that they commonly interfere with their daily functioning. Their disorder can make it hard for them to do their best at work, can interfere with parenting, and can be generally disruptive. 
I spoke to Danielle Vitiello, MD, PhD – a board-certified Obstetrician and Gynecologist and Reproductive Endocrinologist in Progyny’s Provider Network and Medical Director at FCNE – about PMDD.  Dr. Vitiello said, “Women with PMDD have the most pronounced symptoms on the PMS spectrum.  The physical and emotional symptoms are profound and affect activities of daily living. Imagine what it must feel like to look at a calendar and know that you will be physically and emotionally impaired for a predicted week to two weeks, every month?”
Essentially, PMDD is like PMS on overdrive. For most with PMDD, the symptoms exist a week or two prior to their menstrual period, are very severe and usually dissipate right before they start their period. 
And those symptoms aren't only physical. PMDD has been recognized as formal psychiatric disorder since 2013(DSM-V). It’s not known exactly what causes PMDD, but most hypothesize it’s likely due to the shifting hormones produced by your brain and ovaries which regulate your menstrual cycle. People with PMDD have been found to have lower than normal levels of serotonin – the neurotransmitter that regulates mood, sleep, appetite, and sexual function. Serotonin has also been found to be low in those suffering from Depression, so it makes sense that symptoms of PMDD and Depression are remarkably similar: mood swings, intense anger, anxiety, lack of interest in sex, difficulty sleeping, and changes in appetite.  

What is the research/history of the diagnoses?

PMDD is a relatively new discovery. Researchers still aren't sure why some women get PMDD or not. But some suspect that some women are just sensitive to hormone changes than others.
So, what can you do if you believe you have PMDD? 

Talk to your doctor

You should always feel comfortable telling your OBGYN everything about your sexual and reproductive health, including what you are experiencing before, during, and after your period. If you are not comfortable telling your doctor about your body, find a new OBGYN! Trust me on this. If you feel your doctor is not taking your symptoms seriously, again, I would recommend that you find a new OBGYN. Your OBGYN may refer you to a Reproductive Psychiatrist if you are suffering from PMDD, or they may recommend medications. 

Typical treatments for PMDD:

  • You may be put on a medication called a Selective Serotonin Reuptake Inhibitor, or SSRI. SSRIs help regulate the level of serotonin in the brain and can help with a variety of symptoms. SSRIs generally approved for PMDD included Fluoxetine and Sertraline. 
  • Your OBGYN may also recommend that you take birth control pills to help regulate your hormones. Your OBGYN will likely recommend you take an oral contraceptive pill that includes drospirenone, a kind of progesterone.  Brands like Yaz and Beyaz both include drospirenone, and are approved to treat PMDD.
  • The physical symptoms, such as cramps and headaches, can usually be relieved by Ibuprofen or Aspirin. 

Manage your stress

Relaxation techniques, such as breathing exercises and a mindfulness practice, can help relieve your stress levels and emotional symptoms. They can really be a game-changer. If you need help with stress management techniques, talk to a therapist. They are usually able to give you personalized tools to manage your stress. 

Make healthy choices

It can be hard to exercise and eat healthy when you feel gross.  But, especially for those with PMDD, it’s important to take care of yourself. Healthy lifestyle choices have been found to alleviate symptoms. Dr. Vitiello explained that "treatment goals are tailored to relieve symptoms and return women to their lives experienced in the first half of their menstrual cycles. Successful therapies often include lifestyle measures coupled with medication therapies.”  
Asking for help can be difficult. And asking for help about your period or mental health can be especially challenging for some – maybe you feel like you will be judged or not taken seriously. I have found that by far the hardest part is starting the conversation. What’s important is that you find a trusted physician with whom you can discuss this issue, and any aspects of your mental and physical health. You deserve to feel your best all the time!

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Lissa Kline, LCSW is currently the Director of Member Services at Progyny, overseeing the Patient Care Advocates. She worked at Columbia University Medical Center for several years in the division of Reproductive Endocrinology and Infertility. Involved in Patient Services and the Donor Egg Program she loved working with patients while they underwent fertility treatment. Lissa graduated with a Master of Science in Social Work from Columbia University.

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